Provider Demographics
NPI:1245330885
Name:GALLINA, JESSICA B (MD PC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:B
Last Name:GALLINA
Suffix:
Gender:F
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CENTRAL PARK SO
Mailing Address - Street 2:STE 2-0
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-265-0255
Mailing Address - Fax:212-265-0233
Practice Address - Street 1:240 CENTRAL PARK SO
Practice Address - Street 2:STE 2-0
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-265-0255
Practice Address - Fax:212-265-0233
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215872207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI05422Medicare UPIN
NY573G81Medicare PIN